Name:

Date of Birth:

Citizenship Status

Your Address when at School:

Your E-mail Address:

Your Phone Number at School:

Your Home Address:

Home Phone:

Source and Year of High School Degree:

Colleges Attended:

Major:

Expected Date of College Graduation:

Status:

Cumulative Grade Point Average:

Provide names, addresses, and phone numbers of two faculty members you have asked for recommendations.

OPTIONAL (for statistical purposes only)
Please pick a category that describes your ethnic/racial status:

BRIEFLY discuss the following (150 words total). This section is an important part of the selection process.

1. Your plans for future professional or graduate education and eventual plans for a career. 
2. How the Space Center REU experience will contribute to your goals.

List your first three choices among the various research projects. Please specify order of preference.
See the research areas.

IMPORTANT: Print a copy for your records now.

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